Articles
: Facing Your Fears: Overcoming Avoidance After Trauma

By: Dr. Paola Lake

As part of a series of articles on recovery from trauma, this issue describes how to cope with the adverse effects of a traumatic event or experience. If you have been reading previous issues on this topic, you know that a traumatic event refers to an unexpected event that involves actual or perceived threats of serious harm, injury, or death. The effects of a traumatic event can result in a number of unpleasant symptoms, including flashbacks, distressing memories, nightmares, increased arousal, and emotional numbing and avoidance. This article focuses specifically on how facing your anxiety and fear related to the trauma can help in overcoming the effects of trauma. In clinical terms, this is called Exposure Therapy.

In essence, one of the main problems involving a traumatic response is that the event intrudes into one's present life. For example, unwanted memories of a trauma may emerge from unexpected subtle cues, such as a smell, a color, a physical sensation, or the sound of a voice that are reminders of the original trauma. For this reason, trauma survivors typically make efforts to put the past behind them by avoiding thoughts or situations that trigger distressing reminders of the trauma. Unfortunately, avoidance can often serve to perpetuate the unpleasant symptoms associated with the trauma. It also may unnecessarily limit one's functioning in life. For example, if you were involved in a traumatic motor-vehicle accident, you may avoid driving or being in a car because of the anxiety and fear evoked by being in a vehicle. If mobility and travel were important to your lifestyle, ongoing avoidance of driving certainly would lower your quality of life.

In order to overcome the anxiety evoked by reminders of a trauma, you must paradoxically confront the memories or situations that trigger distressing feelings. This may not sound appealing, but doing this ultimately helps decrease the intensity of the fear you experience. It is through confrontation of your fear that the fear dissipates and loses its power. Confronting your fear provides you with the opportunity to learn that your anxiety and fear do not necessarily signify danger. It gives you the opportunity to see that you can survive your feelings without any negative consequence. It also helps you see that you have the capacity to cope with your feelings and that your fears will not control your life.

Depending on the intensity of your posttraumatic symptoms, you may want to consider obtaining help of qualified therapist to help you confront your fears. A therapist can help you lay the groundwork to prepare you to face your fears. First, you will learn how to develop tools to cope with your anxiety. For example, diaphragmatic breathing, relaxation exercises, and cognitive coping strategies can be very helpful in preparing you to manage your symptoms of anxiety.

Cognitive coping involves identifying thoughts and beliefs that strengthen your ability to cope and manage your anxiety. Developing skills in these areas ultimately can decrease the intensity of your anxiety and prevent the onset of debilitating panic symptoms. They also can increase your confidence in your ability to manage anxiety-provoking situations.

A number of different approaches can be used to face memories or situations that trigger unpleasant feelings associated with the trauma. You can face your fears gradually, at a pace that is comfortable for you or, if you feel prepared, face the anxiety-provoking situation all at once. Other options include facing your fears in the imagination or facing your fears in real life. To date, research suggests that real-life exposure is more effective than imagined exposure to the anxiety-provoking situation, however, both can be effective in overcoming trauma-related anxiety.

As an example of the above intervention, I worked with one client who presented with traumatic symptoms following a motor-vehicle accident. She avoided driving as well as being a passenger in a vehicle. This limited her ability to find a job, get to work, or travel any significant distance for holiday visits with significant others. The initial step to facing her fears involved her sitting in a car and managing her anxiety with skills she acquired in therapy. As she mastered her ability to sit in a car, she was asked to drive the car out of the driveway. Her exposure to driving gradually increased from driving for 5 minutes, to 20 minutes, to 2 hours until she was able to drive for an extended distance to another city. Although she continued to be more careful and aware of driving conditions following the accident, her life was no longer limited by her fear. This approach to managing anxiety can be applied to different types of trauma, including trauma related to abuse, domestic violence, natural disasters, etc. Ultimately, facing your fears with courage will release you from the shackles that hold you back from doing or getting what you want in life. As stated by Ambrose Redmoon, "Courage is not the absence of fear, but rather the judgment that something else is more important than fear."